Panel advises depression screening for U.S. teens
Monday, March 30, 2009
CHICAGO -- An influential government-appointed medical panel is urging doctors to routinely screen all American teens for depression -- a bold step that acknowledges that nearly 2 million teens are affected by this debilitating condition.
Most are undiagnosed and untreated, said the panel, the U.S. Preventive Services Task Force, which sets guidelines for doctors on a host of health issues.
The task force recommendations appear in April's issue of the journal Pediatrics. And they go farther than the American Academy of Pediatrics' own guidance for teen depression screening.
An estimated 6 percent of U.S. teenagers are clinically depressed. Evidence shows that detailed but simple questionnaires can accurately diagnose depression in primary-care settings such as a pediatrician's office.
The task force said that when followed by treatment, including psychotherapy, screening can help improve symptoms and help children cope. Because depression can lead to persistent sadness, social isolation, school problems and even suicide, screening to treat it early is crucial, the panel said.
The task force is an independent panel of experts convened by the federal government to establish guidelines for treatment in primary-care. Its new guidance goes beyond the pediatrics academy, which advises pediatricians to ask teen patients questions about depression. Other doctor groups advise screening only high-risk youngsters.
Because depression is so common, "you will miss a lot if you only screen high-risk groups," said Dr. Ned Calonge, task force chairman and chief medical officer for Colorado's Department of Public Health and Environment.
The group recommends research-tested screening tests even for children without symptoms. It cited two questionnaires that focus on depression tip-offs, such as mood, anxiety, appetite and substance abuse.
Calonge stressed that the panel does not want its advice to lead to drug treatment alone, particularly antidepressants that have been linked with increased risks for suicidal thoughts. Routine depression testing should only occur if psychotherapy is also readily available, the panel said. Calonge said screening once yearly likely would be enough.
The recommendations come at a pivotal time for treatment of depression and other mental health problems in children.
Recently passed federal mental health equity legislation mandates equal coverage for mental and physical ailments in insurance plans offering both. The law is expected to prompt many more adults and children to seek mental health care.
Yet at the same time psychiatrists specializing in treating children and teens are scarce. A separate report, also released Monday in the Pediatrics journal, says primary care doctors including pediatricians and family physicians will need to get more involved in mental health care.
That report is from the pediatrics academy and the American Academy of Child and Adolescent Psychiatry. The groups say pediatricians should routinely consult with child psychiatrists, including working in the same office when possible. And it says insurers should compensate pediatricians for any mental health services they provide.
Dr. Alan Axelson, a Pittsburgh psychiatrist who co-authored the second report, praised the task force recommendations and said pediatricians can play a key role.
Because children's families often get to know their pediatricians, having those doctors offer mental health screening can help make it seem less stigmatizing, Axelson said.
Most pediatricians aren't trained to do psychotherapy, but they can prescribe depression medication and monitor patients they've referred to others for therapy, he said.
Dr. Ted Epperly, president of the American Academy of Family Physicians, said his group strongly supports both Pediatrics reports.
While primary care doctors have full plates just dealing with physical ailments, many recognize the importance of providing mental health services -- and many already do, Epperly said.
It isn't always as time-consuming as it might seem; some screening questionnaires can be filled out by patients in the waiting room, Epperly said. Doctors can easily spot any red flags.
On the Net:
Preventive Services Task Force: http://www.ahrq.gov/clinic/USpstfix.htm
American Academy of Pediatrics: http://www.aap.org/
American Academy of Child and Adolescent Psychiatry: http://www.aacap.org/